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HomeMy WebLinkAbout0500 OCEAN STREET (50) r r F TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp �-t Parcel A lication # v Health Division Date Issued ✓�`�—� �" Conservation Division Application Fee-000 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Yqc, 4 - 'nyy, 5220 Ocean S-d° V(yanli/ Village ffyannt'c Owner .�V2vell #0RA9 11I120 Address Telephone Permit Request � /�2 laol �1 MA2-11 910 21 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain a/ai Groundwater Overlay Project Valuation Construction Type -r_Z/l00q10V Lot Size Al, Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ //Multi-Family (# units) Age of Existing Structure AIM Historic House: ❑Yes tMo On Old King's Highway: ❑Yes Dtl0 Basement Type: ❑ Full 1�Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) RJM Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: A existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: #Gas ❑ Oil ❑ Electric ❑ Other Central Air: IyYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing,❑ ngW size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other-=i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w Commercial ❑Yes ❑ No If yes, site plan review# 6M Current Use Proposed Use Ls`s APPLICANT INFORMATION (BUILDER OR HOMEOWNER) L Name 0'r4mZ Telephone Number Address Zl �aI014 �%� License # e,S F/$ Home Improvement Contractor# Worker's Compensation # , ALL CONSTRUCTION DEBRIS RE ULTING FROM THIS PROJECT WILL BE TAKEN TO Y/ SIGNATURE DATE �� t FOR OFFICIAL USE ONLY ., APPLICATION# l DATE ISSUED { MAP/PARCEL NO. { ADDRESS VILLAGE OWNER i I.f DATE OF INSPECTION: =rEOUNDATION FRAME r _ INSULATION j M: FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. '4. ,s3 The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgmmtion/Individual): Id/e Address: "/ ®fix ( � ll�4 o , City/State/Zip:. (2- Phone Are you an employer?Check the appropriate box: Type of project(required): 1.V I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time.).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition. working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'comp. insurance comp.insurance.$ required] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other . comp.insurance required.] *Any applicant that checks box#1.must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractor;have employees,they must provide their workers'comp.policy number.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 4/ l Insurance Company Name:_-, Policy#or Self-ins.Lic. Expiration Date: ce Zt� C a Job Site Address: �©D �C ���• t/��0 /✓0 City/State/Zip: of .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as weIl as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a dayra =ce olator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D coverage verification. I do hereby,certify de ins and penalties of perjury that the information prov d/ed a ove ' /true and correct -Si mature: Date: 7 Z07 Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector•5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more .. of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing'employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on.such dwelling house.' or on the grounds or.building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter.152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial . .Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town.that the application for the permit or Iicense is being requested,not the Department of- ndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured.companie.s should enter-their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. .: Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city.or ' town)."A copy of the-affidavit that has.been officially stamped or marked by the city or town may be provided to the . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or.comm'ercial venture (i.e. a dog license or permit to,bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address,telephone and fax number; The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia CERTIFICATE OF LIABILITY INSURANCE °"'E 10/10/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY ON NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI( BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN . THE ISSUING INSURER(S), AUTHORI REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: il the certificate holdw is an ADzrwNAL INSURED. the cy(les) must be endorsed. If SUBROGATtON IS WAIVED, sub)ecl the terms and.conditions of the policy, certain Policies may require an endorsement. A statement on this Certificate does not confer rights to certificate holder in Ileu of such endorsanent(s). PRODUCER NAME: JAMES R HINDbW Schlegel 6 Schlegel Insurance Brokers Inc PHONE EX1►: 508-771-8381 MM I,508-771-066.1 34 MAIN STREET aoDRess: SCMAGELINSURANCE@VERIZON.NET PRODUCER CUSTOMER ro 0: West Yarmouth, MA 02673 INSURER{SI AFFORDING COVERAGE NAP INSURED INSURERANGM INSURANCE 14788 Viktar Tuleika Dba Tulelka Building CanpanY,LLC NsuRER sAIM INS. 1255 Berkshire Trail INSURERC: INSURER D: West Barnstable, MA 02668 INSURERE: aSURER F: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEi INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE of INSURANCE INSR yyyp POLICY NUMBER RAMOD/YYYY) (MM/DDA YM LIMUS A GENERAL lIASILM MPI6593g 09/30/20 09/30/2014 EACH OCCURRENCE $1,000,000 g <AMMERCIAL GENERAL UABIUTY PREMISES(Ee occurrence) $500,000 CLAfMb•MADE a OCCUR _ MED EXP(Amy ow Parson) $10,000 PERSONAL 6 ADV INJURY 31,000,000 GENERAL AGGREGATE $2,000,000 GEN•L AGGREGATE LIMFF APPLIES PER: PRODUCTS•COMP/OP AGG s2,000,00( POLICY Jr LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UMrr S (Ea accide" ANY AUTO BODILY INJURY(Per person) S ALL OYMiED AUTOS - BODILY INJURY(Per acciderd) S SC6fEDU LEDAUTOS PROPERTYDAMAGE S HIRED AUTOS. (Per accident) N04 DWNM AUTOS S S UMBRELLA LIAR OCCUR EACH OCCURRENCEExcEss S LWS HCLA11118-900E AGGREGATE $ OEDUCTIBLE S RETENTION $ S WORKERS COMPENSATION AND EMPLOYERV LIABILITY X TORY UMFf8 ER B ANYPRoPRiETORIPARTNER;iwcUTIVE YIN NC-5012398 08/26/201 08/26/2014 E.L.EACH ACCIDENT $ 100,000 OFFP;ERIMEMBEREXCLUDEM. ❑ NIA IMandMM In NH) E.L.DISEASE-EA EMPLOYEE S 100,000 Ir yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT s 500,000 -TT i DESCRIPTION OF OPERATIONS/.LOCATIONS/VEIIq£S(Atteah ACORD 101,Additional RemaAa Schedule,If mom space is required) VICTAR TO MR HAS ELECTED COVERAGE ON HIS WORKERS COteENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED 01988-2008 ACORD ORPORATION. All rights n ACORD 26(2009109) The ACORD name and logo are registered marks of ICORD `r>»iWf yrrr Office of Consumer affairs & Busifess Regulation License or registration valid for indiv dul use only OME IMPROVEMENT CONTRACTOR before the expiration date. if round return to: egistratian: 173.709 Type Off ice of Consumer Affairs and Business Regulation ` xpir�tion: 111112014 LLC 10 Park Plaza - Suite 5170 61 -� £ p Boston, MA 02146 TULEIKA BUILDING COMPANY LLC: VIKTAR TULEIKA 125 BERKSHIRE TRAIL W. BARNSTABLE, AAA 02668 Undersecretary Not valid thout signature r } M2ss=husefts . Department of Public S Ing Regul2tions and, Standard Constructla'n -Su penisor U .4 ". CS - + r 4 WestBarn-'stobIOMA WO, � y � Z1 .: 3 222 ' 6 t OA Unrestricted - BuMm'-v of- . ; �PNNIi"" ' . contain, less than. 33 ub e f (991M", Of Wdosed. r' Space. too a � ` w us � a , v ops ijamsting inmo visit: . JWO.S$.Gv, • s�axsr,�te, 16¢ .i Town of Barnstable Regulatory Services Richard V.Seali,.Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,.MA 02601 www.town.barnstable.ma.us Office:.508-862-4038 Fax. .50-196-6230 Property Owner.Must Complete and Sign This. Section If Using A Builder T; _ CyLr t /Mk.(a.wy ,as Owner of the subject property hereb.}authorize to:act.on.tny behalf, .in all matters relative to n ork authorized b�this:building permit application for: (Address o.f job) 2� Signatur of"Owner Date /y k 44 •f d/ fre g/ie N :Print Name If Property Owner is,applying.for permit,pleaw complete the Homeowners License.Ezemption Form on the res•erse side:. p TAKEVtN D\Building ChangeslF-XPRESS PER4ATIEXPRESS,doc Revised 061313 Generated by CamScanner The Yachtsman 500 Ocean Street, Hyannis, MA 02601 Yachtsman Condominium Trust P.O. Box 1283 Hyannis, MA02601-1283 (508)775-1515 Yachtsman Condominium Trust Board of Trustees 500 Ocean Street Hyannis, MA 02601 . .DATE RE: Unit , Yachtsman Condominium Trust,500 Ocean Street, Hyannis To the Town of Barnstable Building Commissioner, The Board of Trustees for.the Yachtsman Condominium Trust voted and approved the attached proposal to be perfed,a .is del' eat n the request we received.from the Unit' Owners. Contractor, lew i -c _ has been contracted by the Unit Owner to perform the work as defined in the proposal. This letter serves as notice of the Board's vote to approve the proposal, which has been noted in w the Minutes of the Board Meeting. Ya ' he P ns and P alties of Perjury this day of 20 es ndomiium Trust et(c/o Manager's Office) Hyannis, MA 02601 Enc./File W .., _. 06 "novy r hn T#r ���a�r27/ ate- S raw !1 i; o C 7 'ISSN i i '�3# S 7'S P GO � � r r . . �f r a� 2111 _ xl r 2 i . _.. _...T _ .. _._........._.... �.